Montana State University

Office of Human Resources

Montana State University
P.O. Box 172520
Bozeman, MT 59717-2520

Tel: (406) 994-3651
Fax: (406) 994-5974
humanresources@montana.edu
Location: 19 Montana Hall

Chief Human Resources Officer

Dennis Defa

Health Benefits for Employees


Below are links to forms and websites to help you answer your benefits questions. For additional assistance please contact Human Resources at 994-3651.

Choices Forms

FY12 (2011-2012)

CHOICES Workbook
CHOICES Enrollment Form
CHOICES Retiree Workbook
CHOICES Retiree Enrollment Form
CHOICES Active Employee Mid-Year Change
COBRA Enrollment Form
MAPP Enrollment Form

General

Adult Dependent
Allegiance Authorization to Release Confidential Information
Allegiance Medical Claim Form
Allegiance Physician's Statement of Disability
Alternate ID Form
Change in Beneficiary
Prescription Reimbursement Form
EyeMed Out of Network Claim Form
Ridgeway Enrollment Form
Family Medical Leave Form
Family Medical Leave Fact Sheet

CHOICES Informational Links

Allegiance Card Instructions (How to Read)
Allegiance Website Guide for Employees
Accidental Death & Dismemberment booklet
Employee Benefit Resources Summary Plan
Group Benefits Plan Book - Indemnity
Group Benefits Plan Book - Managed Care
Health Care & Dependent Care Spending Accounts
Healthy Montana Kids
MEDEX Travel Assist
MSU Benefits Committee
Standard Additional Life Insurance Information
Standard Life & Disability Information
Standard Travel Benefit Brochure
Standard Travel Benefit Brochure (Ex pat-over 90 days)
Standard Travel Benefit Form (Ex pat-over 90 days)
Summary Plan Description

Flexible Benefits Reimbursement

Flex Reduction Agreement Form
FlexConnect Debit Card "Benny Card"
FlexConnect Direct Deposit
Dependent Care Claim Form
Medical Care Claim Form
Letter of Medical Necessity Form
Child Care Contract
Flex Change in Status
Insurance Premium Reimbursement
How to Fill Out a Claim
Eligible and Ineligible Expenses
OTC Communication
Online Claim Submission and Profile Update

Working Families Tax Relief

Declaration of Tax Status of Dependents Form
Working Families Tax Relief Act

Informational Websites

Allegiance
Blue Cross Blue Shield
CHOICES Website
Delta Dental
FlexConnect
Employee Assistance Program
Eye Med
Managed Care Program
Medex
MedImpact
Military Family Leave
Montana University System (MUS)
MUS Benefits Committee Members
New West Health Services
Ridgeway Pharmacy
Self Audit Program
Standard Life Insurance
TLC (The Life Connection)
UNUM Long Term Care Insurance
MSU Wellness
Wellbaby

URx - Prescription Drug Plan

URx Website
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